What's next for VR surgery?

Shafi Ahmed is a surgeon and and co-founder of VR and AR firm Medical Realities

PA

In his office on the first floor of The Royal London Hospital, Dr Shafi Ahmed keeps a classic Polaroid instant camera. Every time he meets a new trainee surgeon, Ahmed draws the camera out and takes a picture of them. "The pic is printed straight away, and I put it in my diary," says Ahmed, a jovial 47-year-old with a mellow voice and an Apple Watch around his wrist. "Then I ask the trainees what they think they'll be doing in ten to twenty years, and I write it under their picture."

If you wonder what Ahmed thinks he'll be doing in ten years, look no farther than his desk, currently piled with several unassembled Google Cardboards. In Ahmed's future, and in his vision of the future of surgery at large, virtual reality will feature prominently.

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On April 14, 2016, Ahmed – a surgeon, cancer specialist, and co-founder of virtual and augmented reality firm Medical Realities – cut off a tumour from the colon of a London man in his 70s. That's a routine operation with no particular risk attached. But unlike any other operation, when Ahmed and his team removed the cancer, a 360-degree camera rig mounted over the operating table captured the doctors' every movement in 4K and livestreamed it globally in VR.

Medical students, surgeon wannabes or anybody who wanted to see and hear what goes on in an operating theatre followed the two-hour intervention at close quarters, using Medical Realities' mobile app and a Cardboard headset. The video's main star, the patient, consented to the initiative, and Ahmed described him as "very supportive of how we are trying to teach medicine around the world."

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To stave off the grim eventuality of broadcasting an operation going awry, Ahmed explains that the video stream was delayed by about one minute. "The operation isn't very risky, but if there's a major complication I'll stop [the stream] immediately," he said before the procedure. "But it's also important that people who are training in medicine see problems. There is not perfect operation, ever. If we have some complications, you have to see how to deal with them."

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As a proud gadget geek – there's a hoverboard next to his office door – and associate Dean at Barts and the London Medical School, Ahmed has spent years experimenting with how consumer technology can benefit healthcare. In 2013, he pestered Google for months until he got hold of a pair of Google Glass, and grabbed headlines by using them to live-stream the removal of a liver cancer from a surgeon's POV. About 13,000 students from 113 countries tuned in, sending Ahmed questions that popped up on the lower corner of his Glass – to which he replied by simply speaking out loud.

When AR and VR started to take off, Ahmed realised they could radically change the way surgery was taught, and solve a health equity crisis on the side.

A 2015 report by the Lancet Commission on Global Surgery revealed that about five billion people worldwide didn't have access to safe surgery. If that is to change, a global shortage of some two million surgeons, anaesthetists and obstetricians will need to be trained over the next 15 years.

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Ahmed travels frequently to medical schools in problematic areas – from Gaza, to sub-Saharan Africa, to his native Bangladesh – for charity reasons. Having witnessed first-hand the lack of infrastructure, training, machinery and even cadavers students in those countries are confronted with, he believes there's no way to attain the Lancet's goal without radical change. "Me going there is good, but inefficient. Forget about the individual, forget about going somewhere and training two or three surgeons. Let's focus on how we scale up to be able to train many people around the globe, in different parts of the world, especially in low-income countries." he says " When it comes to that, helping a few people won't solve the world's problems. But if people can use an Oculus, or a Cardboard to witness surgery on their smartphones, you can do much greater good." "Thousands of medicine students can be trained by someone in Harvard, or in London, or in Rome. All they need is a smartphone's 3G or 4G connection."

That's not just wishful thinking. Medical Realities, the company Ahmed founded in early 2015 together with VR innovator Steve Dann, is currently working to launch software that will enable Ahmed to teach remotely using 360-degree streaming and AR. Ahmed is also considering swapping his Google Glass with a new model of AR specs developed by San Francisco-based Osterhout Group. "I recently went to Gaza to talk about how to raise health standard in a country that's barricaded. I thought: 'How do we free this people's minds?'," Ahmed says. "Now, with these technologies, I can regularly teach surgery to Gaza medicine students. I'll be part of a medical school there, but I'll be teaching from here remotely."

VR could change traditional surgery training the West, too. Ahmed argues that the operating theatre's makeup hasn't really changed for centuries, and today students end up craning their necks for hours just to catch a vague glimpse of the action over the surgeon's shoulder.

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Paradoxically, he says, close-up immersive streams could make trainees "feel part of the operation" more than if they were in the theatre. But surgery is a tactile job of lancets, scalpels and drills. To recreate that in VR, you need tactile feed.

VR livestreams are the first step to what Ahmed calls "the virtual surgeon" – a project that involves shifting from live-capture VR to full computer-rendered simulations of surgical operations. And eventually, reactive virtual patients and gloves to provide tactile feedback. "In my vision, you'll have a virtual body in front of you, you get haptic gloves, you pick up a scalpel, and you feel it normally, you make a cut, you see the incision, it's all realistic," he says. "Ultimately, people will be able to use VR to carry out operations and train themselves through virtual operations. That'd be our endgame." And that endgame might not be too far away: Ahmed predicts the necessary advances in VR and haptic technology could be just five years away.

But when what? Ahmed has another theory, which relates to Ray Kurzweil's concept of singularity. The actual endgame, his argument goes, will be when AI and robots have developed to a point that they can carry out surgery better than human doctors can. "I call it 'surgical singularity'. And at some point it's definitely going to happen: it's just a question of when," he says. "In the meanwhile, we'll keep investing in VR. Robotic surgeons won't be here for a few years yet."